Abstract

In the Northwest Territories (NT) of Canada, equitable access to cancer care remains a significant challenge, particularly for First Nations, Inuit, and Métis (FNIM) residents. Many of the most rural and remote communities—where FNIM populations are most concentrated—face geographic isolation that requires patients to travel long distances, often to Yellowknife, NT or Edmonton, Alberta (AB), for extended periods to access specialized oncology and radiology services.

This geographic disparity contributes to a range of barriers along the cancer care continuum, including delayed diagnoses, higher mortality rates, challenges navigating a complex health care system, and increased financial burdens. These factors disproportionately affect FNIM residents and hinder timely, effective care.

In response, the Northwest Territories Health and Social Services Authority (NTHSSA) has developed and introduced innovative, nurse-led models of cancer care designed to address systemic inequities and meet the increasing demand for cancer screening, treatment, resource and supportive services.

These models emphasize equity-oriented care and are tailored to the unique needs of NT. Key components include improved access to care closer to home, comprehensive care coordination, culturally safe symptom assessment and management, diagnostic follow-up, streamlined appointment scheduling to reduce unnecessary travel, and consistent support from specialized oncology nurses. These nurses are uniquely equipped with expertize in both cancer care and the lived realities of remote Northern communities.

By leveraging these nurse-led models, the NTHSSA aims to reduce health disparities and enhance the quality and accessibility of cancer care for FNIM residents across the Northwest Territories.

Abstract 

Cancer diagnostics and therapy increasingly rely on genomic analysis to guide personalized treatment strategies. Two primary approaches for genomic assessment are the detection of somatic variants, which arise in tumor cells, and germline variants, which are inherited and present in all cells of the body. Somatic mutations provide direct insights into tumor-specific alterations, enabling targeted therapies such as EGFR inhibitors in lung cancer or BRAF inhibitors in melanoma. In contrast, germline variants help identify hereditary cancer predisposition syndromes, guiding early detection and risk reduction strategies, as seen in BRCA1/2-related breast and ovarian cancers.

Both approaches have distinct advantages and limitations. Somatic testing offers real-time insights into tumor evolution and therapy resistance, while germline testing aids in understanding inherited risks and optimizing treatment selection. Emerging technologies, such as whole-genome sequencing and liquid biopsies, are improving the accuracy and feasibility of both methods. An integrated strategy combining somatic and germline testing may provide the most comprehensive framework for precision oncology.

Prioritizing one approach over the other depends on clinical context, tumor type, and therapeutic goals. Future directions include refining bioinformatics pipelines, expanding access to genetic testing, and addressing ethical and clinical implications of variant detection in oncology